TITLE:
Coronary Physiology in the Management of CAD Patients: Position Paper Regarding the Current Scenario in India
AUTHORS:
Sridhar Kasturi, Ramneek Kaur, Manish Narang, Surinder Kher
KEYWORDS:
Coronary Physiology, Fractional Flow Reserve, Percutaneous Coronary Intervention, Revascularization
JOURNAL NAME:
World Journal of Cardiovascular Diseases,
Vol.13 No.11,
November
29,
2023
ABSTRACT: Fractional flow reserve (FFR), a physiology-based
diagnostic method, has emerged as an important decision-making tool in
determining the borderline or intermediate coronary lesions requiring
revascularization. As per the guidelines recommended by European and American
cardiology associations, functional assessment of indeterminate lesions is to
be considered strongly prior to PCI. However, in India, FFR continues to be a
much-underutilized tool due to limited facilities, and many times, physicians
are reluctant to advise FFR because of its time-consuming nature with
additional cost implications of simple diagnostic tests. Notably, for stenoses
ranging between 50% - 70% where the choice between revascularization and
medication becomes ambiguous, FFR provides invaluable insight. Without such
guidance, there is a risk of improper decisions and strategies while planning
revascularization procedures, which might adversely influence clinical
outcomes, escalation of the cost due to unnecessary procedures, and prolonged
hospitalization as a result of simple vs complex procedures. Landmark studies
have validated the efficacy of FFR in enhancing outcomes in coronary artery
disease (CAD) patients, especially when paired with a coronary angiogram. This
combination provides robust evidence of the functional significance of stenosis
in stable CAD. Additionally, non-hyperemic pressure ratio indices correlate well
with conventional FFR. Hence, adopting
FFR-guided management can have transformative effects on the clinical
and economic facets of treating severe CAD with intermediary lesions in Indian
settings.